The study authors found that in 2018, approximately 5 million middle and high school students currently used any tobacco product, with over 3.6 million currently using e-cigrettes and about half (2.5 million) currently using a combustible tobacco product, such as cigarettes and cigars. For the fifth year in a row, e-cigarettes continued to be the most commonly used tobacco product among U.S. youth. Among current tobacco product users, 41.7 percent of high school students and 33.3 percent of middle school students used two or more tobacco products. E-cigarette and cigarette use was the most common combination among those using multiple products.

Changes in Current Use Between 2017 and 2018

From 2017 to 2018, use of any tobacco product increased significantly by 38.3 percent (19.6% to 27.1%) among high school students and by 28.6 percent (5.6% to 7.2%) among middle school students. Current e-cigarette use increased significantly by 77.8 percent (11.7% to 20.8%) among high school students and by 48.5 percent (3.3% to 4.9%) among middle school students between 2017 and 2018. Furthermore, frequent e-cigarette use (more than 20 days in the past 30 days), increased significantly by 38.5 percent (20.0% in 2017 to 27.7% in 2018) among high school students who were current e-cigarette users.

Due to the alarming nature of these findings, they were released early in a Notes from the Field article in Nov. 2018. The current study finds that e-cigarettes were the primary driver of the increase in current use of any tobacco product among both middle and high school students. During this same period, although there were no significant changes in current use of combustible tobacco products, such as cigarettes and cigars, there was a slight uptick in any combustible tobacco product use (12.9% to 13.9%) and current cigarette use (7.6% to 8.1%) among high school students.

The high rates of youth tobacco use, particularly e-cigarette use, continue to be of concern to FDA. Last spring, FDA launched the Youth Tobacco Prevention Plan, which aims to prevent youth access to tobacco products; curb marketing of tobacco products aimed at youth; and educate teens about the dangers of using any tobacco product, including e-cigarettes, as well as educate retailers about their key role in protecting youth.

As part of the plan, FDA has ramped up efforts around compliance of the marketing and sales of e-cigarettes and conducted an ongoing series of enforcement actions to prevent initiation of tobacco products, including e-cigarettes, by youth. FDA continues to invest in compelling, science-based campaigns to educate youth about the dangers of all tobacco products. In Sept. 2018, FDA launched the full-scale youth e-cigarette prevention effort under “The Real Cost” brand umbrella. In Nov. 2018, the concerning findings from the 2018 NYTS youth e-cigarette use data prompted FDA to outline a policy framework on actions to reduce youth e-cigarette use, targeting the central problems – youth appeal and access to flavored tobacco products.

To learn more about FDA’s latest actions, and upcoming plans, read the FDA Commissioner’s statement on the release of the new findings.